Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Bristol Eye Hospital, Bristol, United Kingdom.
Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ophthalmology. 2021 Mar;128(3):410-416. doi: 10.1016/j.ophtha.2020.07.039. Epub 2020 Jul 24.
To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery.
Cohort study.
Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland.
Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included.
Neovascular age-related macular degeneration-free survival.
Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n = 88; non-BLF group, n = 76). The nAMD-free survival was similar between the groups (P = 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79-1.47; P = 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P = 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P = 0.527), number of anti-vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P = 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P = 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n = 71; non-BLF, n = 74), the clinical outcomes again were comparable (all P > 0.05).
In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.
评估蓝光过滤（BLF）人工晶状体（IOL）在预防白内障手术后新生血管性年龄相关性黄斑变性（nAMD）中的作用。
队列研究。
芬兰科特卡凯梅拉奥克索中心医院眼科于 2007 年至 2018 年间接受无并发症白内障手术的患者。
比较接受 BLF IOL 和非 BLF IOL 患者的后续 nAMD 发生率。评估总体发生 nAMD 风险的 Kaplan-Meier 和 Cox 回归分析。最佳矫正视力（BCVA）、中心凹厚度、治疗间隔和玻璃体腔内注射总数为次要结果。对存在预先存在的 nAMD 的患者进行了单独的分析，以评估 BLF IOL 对 nAMD 进展的影响。纳入每例患者的单眼。
无新生血管性年龄相关性黄斑变性生存。
共纳入 11397 例患者的 11397 只眼，平均年龄为 75.4±8.3 岁（62.5%为女性）。5425 只眼（47.6%）使用 BLF IOL，5972 只眼（52.4%）使用非 BLF IOL。在随访期间（BLF IOL 组，55.2±34.1 个月；非 BLF IOL 组，50.5±30.1 个月；P<0.001），记录了 164 例新发 nAMD（BLF 组，n=88；非 BLF 组，n=76）。两组间 nAMD 无生存差异（P=0.465，对数秩检验）。在控制年龄、性别和记录的黄斑变性诊断的 Cox 回归分析中，BLF IOL 的使用与 nAMD 发展无关（风险比[HR]，1.075；95%置信区间[CI]，0.79-1.47；P=0.652）。在 nAMD 患者中，1 年时的次要临床结局在 BCVA（0.57±0.4 最小角分辨率对数与 0.45±0.4 最小角分辨率对数；P=0.136）、中心凹厚度（285±109μm 与 299±103μm；P=0.527）、抗血管内皮生长因子注射次数（6.5±2.5 与 6.2±2.7；P=0.548）和治疗间隔（7.5±2.4 周与 8.1±2.4 周；P=0.271）方面，BLF 和非 BLF IOL 之间无差异。同样在手术后发生 nAMD 的患者中，在术前存在 nAMD 的患者中（BLF，n=71；非 BLF，n=74），临床结局再次无差异（均 P>0.05）。
在接受白内障手术的大患者队列中，与非 BLF IOL 相比，BLF IOL 在 nAMD 的发生或进展，或与 nAMD 严重程度相关的临床变量方面没有明显优势。
